My brother is an engineer. Yes, he’s a firefighter and occasionally he still drives the Fire Truck, but I’m not talking about being an engineer as it relates to the fire service. I’m talking about a pocket-protector wearing, slide-rule-sliding Engineer who draws lines on paper and calculates weight to strength ratios and the like. It’s math that’s way over my head and I’m glad that he’s the one that has to do that type of work every day and not me. When he explains his job to me my brain starts to overheat and I’m surprised that my hair hasn’t caught on fire yet. It started smoking once, but I was able to catch a glimpse of “The Hills” on the TV and it slowed my mental activity just in time.

My brother, Captain Kaiser, is a volunteer fire captain and he used to be an EMT although he let it lapse due to the fact that it limited time with his family. I guess that I got the EMS genes and he got the “go to college and get a real job that pays well” genes. I say more power to him and he’s one of my best friends. I don’t get to see him as much as I should, but we talk often on the phone. He has always been interested in hearing all of my tales of EMS glory, and I listen to tales of his two daughters. Raising daughters sounds waaaay different than raising my son.

The other day I was talking to him about “this blogging stuff I do” and I breached the subject of EMS 2.0. I haven’t written much about EMS 2.0 by name lately, although the concepts I’ve been bringing forth fit into my model of it, but trust me when I say there has been a lot of behind the scenes activity. It turned into an interesting conversation with my brother. He was an EMT but never got past the volunteering when his community needs him stage. That’s an honorable place to be, no doubt, but he didn’t delve into the level that I take it to. So explaining EMS 2.0 to him was close to explaining it to an educated lay person.

In the conversation, I brought up the scenario that I used to write the post: “Are We the Gatekeepers to the Emergency Healthcare System?” (Unofficially titled, “Did I do good?”) and explained to him how I evaluated a patient in a nursing home, performed a full assessment on her including a 12-lead EKG and a review of her recent lab work, held a telephone conference with her Primary Care Physician and the Nursing staff on scene, and triaged the patient to the Primary Heathcare System as opposed to the Emergency Healthcare System. In the process, I saved the healthcare system (in the form of Medicare) thousands of dollars and provided better care to the patient by deferring her from the emergency room. I explained to him that my ambulance service could not bill the patient for the care I provided her because we did not transport and that the current system needs to recognize the value in having EMS provide such services in terms of cost-savings. If I would have transported, our service would have made the revenue, but Medicare would have paid thousands of dollars in unnecessary care overall. Since I didn’t, I saved Medicare thousands, but the service wasn’t valued and we didn’t receive any compensation for our work.

Basically, the conversation wound up being that he agreed with me that EMS has a powerful position to improve access to primary care and “save” healthcare as it were by increasing access to primary care, properly deferring patients from the emergency healthcare system when their care could be more appropriately managed in the primary care setting, and by saving millions of dollars in the overall healthcare setting. He agreed with me that it would require deregulation of the EMS industry to allow us to attempt programs and offer new services outside of our current mold and would require increased education of street-level EMS providers to get this done. He also agreed with me that money we’re already collectively spending should be allocated from inefficient programs and given to efficient high-performance EMS systems to do this in order to realize greater savings.

Remember, he’s an engineer. He’s good at math. He may not be a healthcare provider currently schlepping patients around in a shiny red and white bus that makes “woo woo” sounds, but he’s as smart as they come…

And when I told him that he’s exactly who we should be getting our message out to, he disagreed. He thinks that we should be out there talking to politicians and Insurance Industry executives. Honestly, he chastised me for not being in my local congresshuman’s office to do just that.

So, here’s a shoutout to the politicos out there: “EMS can ‘save’ healthcare through a free-market, grass-roots, innovative solution using currently available resources. We can save millions and improve the entire healthcare system just by putting in place a few good ideas and allowing EMS professionals the ability to think outside of the box”.

So do me a favor, y’all. Go tell your local politico to e-mail me at Proems1@yahoo.com. I’d love to have a talk with them. You should too.

He's an engineer, but he's not a politician. EMS doesn't have political clout and I don't see it happening in the future. Paramedics, let alone EMTs, don't have the training or education to act as gatekeepers. If someone decides that what we call EMS is going to do this function they are either going to educate us to be able to do it or, and this is far more likely, change the definition of who works in EMS. Which means other medical personnel are going to end up doing it.

I agree with your brother. EMS does not go a good enough job of speaking the same brand of language as your local congress critter. Additional factors complicate matters: there's too much patronage in the system (in my area at least), too many conflicts of interest and don't even forget about that too many in EMS (and the fire service by extension) too often either have a chip on their shoulders or are in cahoots with the politicos in question.

A culture shift will have to take place on many levels. But I do agree with your brother.

He's an engineer, but he's not a politician. EMS doesn't have political clout and I don't see it happening in the future. Paramedics, let alone EMTs, don't have the training or education to act as gatekeepers. If someone decides that what we call EMS is going to do this function they are either going to educate us to be able to do it or, and this is far more likely, change the definition of who works in EMS. Which means other medical personnel are going to end up doing it.

I agree with your brother. EMS does not go a good enough job of speaking the same brand of language as your local congress critter. Additional factors complicate matters: there's too much patronage in the system (in my area at least), too many conflicts of interest and don't even forget about that too many in EMS (and the fire service by extension) too often either have a chip on their shoulders or are in cahoots with the politicos in question.

A culture shift will have to take place on many levels. But I do agree with your brother.

http://twitter.com/JDS753 Josh Scott

As much as I would like to think that EMT's are the masters of this stuff, but shouldn't the ECF that you were at be competent enough in their training to be able to tell the pt didn't NEED to go to the ER? This seems (and I see it a LOT in private) like the problem we have here

http://twitter.com/JDS753 Josh Scott

As much as I would like to think that EMT's are the masters of this stuff, but shouldn't the ECF that you were at be competent enough in their training to be able to tell the pt didn't NEED to go to the ER? This seems (and I see it a LOT in private) like the problem we have here

http://www.kslights.com led street lights

This is a Great article!! Love the info.

Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

mr618Patient Friendly JokesThad, I had the opportunity to work in Joplin with the Red Cross after the 2011 tornado. Great city, great people. Hope things are returning to normal for you.
2015-02-13 18:05:00

mr618Patient Friendly JokesNo, Mr Roughton, I think that applies to YOU. If SheraPrincess says something tat makes a patient laugh, smile, or even fel just a LITTLE bit less stressed/worried/hurt.. go for it. You sound so unpleasant and burnt-out, you ought to think about retiring (f you even work in this field).
2015-02-13 18:01:00

Braden PetersWhy do Ambulances Carry Epi-Pens?The filter needles is not even necessary. You can draw up the epinephrine from an ampule and give it using the same needle. This is routine practice in most of the world, including Canadian EMS. Unfortunately, the EMR (EMT-B) level here also does not have epi, or if they do, it is in an autoinjector.…
2015-01-09 22:13:00

Braden PetersEMS Use of the PERC Rule for Pulmonary EmbolismGreat Article. I learned somthing new. One thought: "The PERC rule states that if any of those questions are a â€śYES PE cannot be ruled outâ€ť A better way to phrase that as used on the LIFTL post you reference would be "the answer to ALL of the questions must be NO..." and then slightly…
2015-01-09 19:44:00